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Small bowel obstruction caused by intrauterine device infection

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Abstract

A 39-year-old previously healthy woman was referred to our emergency department by a primary care doctor on suspected to be acute enteritis, complaining of fever, anorexia, lower abdominal pain, and frequent diarrhea. The day after admission, although frequent diarrhea stopped, the abdominal distension worsened. An abdominal radiograph revealed several dilated loops of the small bowel, suggested that small bowel obstruction (SBO) had developed. White blood cell count and c-reactive protein were markedly increased, and abdominal contrast-enhanced computed tomography scan showed localized severely edematous bowel mucosa, increased adipose tissue concentration in the pelvis, and a beaded low absorption area in the uterus. Gynecological examination revealed the presence of a pus-filled plastic intrauterine device (IUD) in the uterus. The patient confided that she had sex with her husband 2 days before the onset of symptoms. A diagnosis of SBO due to pelvic peritonitis caused by IUD infection during sexual activity was made. The SBO was cleared in 12 days with fasting, peripheral parenteral nutrition, antibiotic treatment, and insertion of an ileus tube. This case reminds us that it needs to consider disorders associated with the uterine appendages, in women of reproductive age with lower abdominal pain.

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References

  1. Hsia JK, Creinin MD. Intrauterine contraception. Semin Reprod Med. 2016;34:175–82.

    Article  Google Scholar 

  2. Antonelli D, Kustrup JF Jr. Large bowel obstruction due to intrauterine device: associated pelvic inflammatory disease. Am Surg. 1999;65:1165–6.

    CAS  PubMed  Google Scholar 

  3. Brar R, Doddi S, Ramasamy A, et al. A forgotten migrated intrauterine contraceptive device is not always innocent: a case report. Case Rep Med. 2010;2010:740642.

    Article  Google Scholar 

  4. Jones D. Young woman with abdominal pain. Small bowel obstruction caused by IUD migration. Ann Emerg Med. 2014;64:423–5.

    Article  Google Scholar 

  5. Loveless A, Dhari A, Kilpatrick CC. Perforated levonorgestrel-releasing intrauterine system resulting in small bowel obstruction: a case report. J Reprod Med. 2014;59:611–3.

    PubMed  Google Scholar 

  6. Xu JX, Remedios E, Duthie A, et al. Intrauterine contraceptive device: cause of small bowel obstruction and ischaemia. ANZ J Surg. 2017;87:E319–20.

    Article  Google Scholar 

  7. Nasu K, Matsumoto H, Yoshimatsu J, et al. Ureteral and sigmoid obstruction caused by pelvic actinomycosis in an intrauterine contraceptive device user. Gynecol Obstet Invest. 2002;54:228–31.

    Article  Google Scholar 

  8. Rudensky B, Abramowitz H, Yinnon AM, et al. Intrauterine device as source of pneumococcal intra-abdominal infection and small-bowel obstruction. Eur J Clin Microbiol Infect Dis. 2004;23:576–7.

    Article  CAS  Google Scholar 

  9. Horvat M, Kovacic S, Potrc S, et al. Abdominal actinomycosis presenting as a small-bowel obstruction. Wien Klin Wochenschr. 2004;116(Suppl 2):97–9.

    PubMed  Google Scholar 

  10. Biyani DK, Denley H, Hill J, et al. IUCD induced abdomino-pelvic actinomycosis presenting as acute large bowel obstruction. J Obstet Gynaecol. 2007;27:870–1.

    Article  CAS  Google Scholar 

  11. Nozawa H, Yamada Y, Muto Y, et al. Pelvic actinomycosis presenting with a large abscess and bowel stenosis with marked response to conservative treatment: a case report. J Med Case Rep. 2007;1:141.

    Article  Google Scholar 

  12. Sivakumar R, Bhatti I, Bali A, et al. Gynaecological cause for bowel obstruction. Gut. 2009;58(1466):544.

    Google Scholar 

  13. Nissi R, Sequeiros RBB, Lappi-Blanco E, et al. Large bowel obstruction in a young woman simulating a malignant neoplasm: a case report of actinomyces infection. Case Rep Obstet Gynecol. 2013;2013: 756768.

    CAS  PubMed  PubMed Central  Google Scholar 

  14. Yang SS, Im YC. Severe abdominopelvic actinomycosis with colon perforation and hepatic involvement mimicking advanced sigmoid colon cancer with hepatic metastasis: a case study. BMC Surg. 2018;18:51.

    Article  Google Scholar 

  15. ten Broek RP, Issa Y, van Santbrink EJ, et al. Burden of adhesions in abdominal and pelvic surgery: systematic review and met-analysis. BMJ. 2013;347:f5588.

    Article  Google Scholar 

  16. Miller G, Boman J, Shrier I, et al. Etiology of small bowel obstruction. Am J Surg. 2000;180:33–6.

    Article  CAS  Google Scholar 

  17. Zissin R, Hertz M, Paran H, et al. Small bowel obstruction secondary to Crohn disease: CT findings. Abdom Imaging. 2004;29:320–5.

    Article  CAS  Google Scholar 

  18. Idelevich E, Kashtan H, Mavor E, et al. Small bowel obstruction caused by secondary tumors. Surg Oncol. 2006;15:29–32.

    Article  Google Scholar 

  19. Seike T, Yamato M, Suda T, et al. A case of small bowel adenocarcinoma that caused intestinal obstruction after administration of patency capsule. Clin J Gastroenterol. 2020;13:522–6.

    Article  Google Scholar 

  20. Tepper NK, Steenland MW, Gaffield ME, et al. Retention of intrauterine devices in women who acquire pelvic inflammatory disease: a systematic review. Contraception. 2013;87:655–60.

    Article  Google Scholar 

  21. Farley TM, Rosenberg MJ, Rowe PJ, et al. Intrauterine devices and pelvic inflammatory disease: an international perspective. Lancet. 1992;339:785–8.

    Article  CAS  Google Scholar 

  22. Campbell SJ, Cropsey KL, Matthews CA. Intrauterine device use in a high-risk population: experience from an urban university clinic. Am J Obstet Gynecol. 2007;197:193.e1-6 (discussion e6–7).

    Article  Google Scholar 

  23. Westhoff C. IUDs and colonization or infection with actinomyces. Contraception. 2007;75:S48-50.

    Article  Google Scholar 

  24. García-García A, Ramírez-Durán N, Sandoval-Trujillo H, et al. Pelvic actinomycosis. Can J Infect Dis Med Microbiol. 2017;2017:9428650.

    Article  Google Scholar 

  25. Laurent T, de Grandi P, Schnyder P. Abdominal actinomycosis associated with intrauterine device: CT features. Eur Radiol. 1996;6:670–3.

    Article  CAS  Google Scholar 

  26. Myers LL, Shoop DS, Stackhouse LL, et al. Isolation of enterotoxigenic Bacteroides fragilis from humans with diarrhea. J Clin Microbiol. 1987;25:2330–3.

    Article  CAS  Google Scholar 

  27. Keenan JE, Turley RS, McCoy CC, et al. Trials of nonoperative management exceeding 3 days are associated with increased morbidity in patients undergoing surgery for uncomplicated adhesive small bowel obstruction. J Trauma Acute Care Surg. 2014;76:1367–72.

    Article  Google Scholar 

  28. Catena F, Di Saverio S, Kelly MD, et al. Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2010 evidence-based guidelines of the World Society of Emergency Surgery. World J Emerg Surg. 2011;6:5.

    Article  Google Scholar 

  29. Diaz JJ Jr, Bokhari F, Mowery NT, et al. Guidelines for management of small bowel obstruction. J Trauma. 2008;64:1651–64.

    PubMed  Google Scholar 

  30. Schraufnagel D, Rajaee S, Millham FH. How many sunsets? Timing of surgery in adhesive small bowel obstruction: a study of the nationwide inpatient sample. J Trauma Acute Care Surg. 2013;74:181–7 (discussion 7–9).

    Article  Google Scholar 

  31. Teixeira PG, Karamanos E, Talving P, et al. Early operation is associated with a survival benefit for patients with adhesive bowel obstruction. Ann Surg. 2013;258:459–65.

    Article  Google Scholar 

  32. Dellinger RP, Levy MM, Rhodes A, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med. 2013;39:165–228.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Gastroenterology, Kanazawa Municipal Hospital, 3-7-3, Heiwa-machi, Kanazawa, Ishikawa, 921-8105, Japan

    Takuya Seike, Tsuyoshi Suda & Naoki Oishi

  2. Department of Gastroenterology, Graduate School of Medicine, Kanazawa University, Kanazawa, Ishikawa, Japan

    Takuya Seike & Tsuyoshi Suda

  3. Department of Obstetrics and Gynecology, Kanazawa Municipal Hospital, Kanazawa, Ishikawa, Japan

    Taro Kanaya

Authors
  1. Takuya Seike
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  2. Taro Kanaya
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  3. Tsuyoshi Suda
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  4. Naoki Oishi
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Correspondence to Takuya Seike.

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All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Seike, T., Kanaya, T., Suda, T. et al. Small bowel obstruction caused by intrauterine device infection. Clin J Gastroenterol 14, 1419–1425 (2021). https://doi.org/10.1007/s12328-021-01476-6

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  • DOI: https://doi.org/10.1007/s12328-021-01476-6

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